Healthcare Provider Details

I. General information

NPI: 1265870679
Provider Name (Legal Business Name): CORINNE GRESS MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 E OLIVE ST
LONG BEACH NY
11561-3708
US

IV. Provider business mailing address

649 E OLIVE ST
LONG BEACH NY
11561-3708
US

V. Phone/Fax

Practice location:
  • Phone: 516-776-5369
  • Fax:
Mailing address:
  • Phone: 516-776-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number007760
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number919222
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number919222
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number919222
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number919222
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number007760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: